Deviation in the Standard of Obstetrical Care During a Cesarean Section

Evaluate breaches in the standard of care when evaluating whether or not there was a Deviation in the Standard of Obstetrical Care During a Cesarean Section

Answer the following questions to find out if the standard of care was followed for your case.

With which of the following risk factors did the patient present? (Choose all that apply)Prior large for gestational age babiesShoulder dystociaGestational diabetes mellitusInstrumental deliveryDysfunctional laborPrevious cesarean sectionAnswer unknownNone elicitedWhy is this important?Risk factors are useful for identifying patients at increased risk for a disease or for a particular outcome that results from a disease process.Click here for additional information at ClinicalKey.com

Did the clinician identify and document any of the following during the course of pregnancy? (Choose all that apply) Why is this important?Answer this questionThe most prevalent maternal medical risk factors that are associated with primary and repeat cesarean delivery are anemia, diabetes mellitus and hypertension.(2011) 38 ECLPER 2 297-309

Which of the following clinical conditions were present? (Choose all that apply) Why is this important?Answer this questionThe indications for primary cesarean delivery include breech presentation, dystocia (abnormal or difficult labor), fetal distress or maternal medical and obstetric risk factors.(2004) 190 ESAJOG 1 10-19

Was an emergency cesarean section performed? Why is this important?Answer this questionAn emergency cesarean delivery is defined as a cesarean delivery that is performed after labor has begun.(2012) 36 ESMPER 5 384-389

Did the clinician obtain and document a detailed informed consent? Why is this important?Answer this questionThe laws of most states require that clinicians obtain informed consent before providing treatment.(2011) 23 EOMSCA 3 475-484

When was the patient’s last full meal? Why is this important?Answer this questionThe gastric volume predisposing a patient to aspiration is 30 ml or more.(2004) 18 EBPRCA 4 719-737

Did an anesthesiologist evaluate the patient prior to the procedure? Why is this important?Answer this questionConsultation with an anesthesiologist prior to the procedure is necessary to evaluate the patient and to determine if general anesthesia or regional anesthesia (spinal or epidural) is to be used.(2005) 14 IJOBAN 2 147-158

Did the clinician perform baseline laboratory tests? Why is this important?Answer this questionLaboratory investigations are necessary to assess the overall status of the patient. Baseline blood investigations must include complete blood count (CBC), type and cross match, and coagulation studies. Blood gases are necessary to determine the patient’s respiratory status.Click here for additional information at ClinicalKey.com

Did the clinician anticipate the need for a possible blood transfusion? Why is this important?Answer this questionPregnancy itself may cause anemia. Additional predisposing factors for transfusion include placental abnormalities, eclampsia, general anesthesia and a history of multiple cesarean deliveries.(2005) 14 IJOBAN 2 147-158

Did the patient receive prophylactic antibiotics? Why is this important?Answer this questionIn order to reduce the risk of post-operative infection, a single intravenous dose of a narrow spectrum antibiotic needs to be administered pre-operatively to all women undergoing cesarean delivery.(2005) 14 IJOBAN 2 147-158

Did the patient with a high risk of thromboembolism receive prophylactic anti-coagulants? Why is this important?Answer this questionFor women undergoing cesarean delivery at high risk of venous thrombo-embolism, both mechanical prophylaxis and pharmacological prophylaxis are recommended. Pharmacologic prophylaxis is begun 6 to 12 hours postoperatively, after concerns for hemorrhage have decreased.(2005) 14 IJOBAN 2 147-158

Was the fetal heart rate monitored and documented prior to the procedure? Why is this important?Answer this questionGuidelines on electronic fetal heart monitoring recommend that where acute fetal compromise is suspected as in severe fetal bradycardia, delivery must occur as soon as possible.(2005) 14 IJOBAN 2 147-158

Was a Foley catheter inserted? Why is this important?Answer this questionIn non-emergency situations, a Foley catheter may be placed after adequate anesthesia. The catheter facilitates bladder drainage during the procedure and for the subsequent 12-24 hours.(2005) 14 IJOBAN 2 147-158

Were the vital signs monitored before and during the administration of anesthesia? Why is this important?Answer this questionThe mother's blood pressure, pulse, and oxygen saturation needs to be monitored throughout the procedure, starting before provision of anesthesia.(2005) 14 IJOBAN 2 147-158

Which of the following intra-operative complications did the patient experience? (Choose all that apply) Why is this important?Answer this questionSevere hypotension with bradycardia can occur after administration of anesthesia. Methods commonly used to prevent or treat hypotension, include fluid pre-loading, the use of medication administration, positioning and vasopressor therapy.(2008) 17 IJOBAN 4 292-297

Did the clinician call for the assistance of a pediatrician or a neonatologist? Why is this important?Answer this questionInternational guidelines on neonatal resuscitation and pediatric care state that an appropriately trained practitioner is to be present at all births by cesarean section.(2005) 193 ESAJOG 3 599-605

Did the infant sustain any physical injuries during the delivery? Why is this important?Answer this questionExtreme care and precision is needed to ensure that instrument lacerations are avoided. This complication is more likely if there has been rupture of membranes or if there is oligohydramnios.(2003) 21 EMDCNA 3 679-693

Post-operatively, was documentation made of the mother’s vital signs, urinary output, bowel sounds and surgical wound condition? Why is this important?Answer this questionPost-operative care includes taking vital signs every 15 min for the first 2 hrs, monitoring urine output hourly, palpating the fundus and expressing the clots immediately, examining the surgical wound for signs of infection and auscultating the abdomen for the return of bowel sounds.(2005) 14 IJOBAN 2 147-158

Which of the following post-operative complications did the patient experience? (Choose all that apply) Why is this important?Answer this questionThe infected wound is tender, inflamed, indurated, or drains purulent material. Also it is recommended that wound infection be suspected in febrile patients.(2012) 39 EPCCOP 1 145-165